150例儿童上呼吸道感染患者咽拭子涂片细菌培养结果及其耐药性分析

目的:探究儿童患者咽拭子标本涂片镜检与细菌培养结果,分析上呼吸道感染患者产超广谱β-内酰胺酶(ESBLs)肠杆菌科细菌的耐药情况,为临床合理选用抗菌药物提供参考。方法:选取2018年7月—2020年3月期间医院上呼吸道感染门诊患儿咽拭子标本150例资料,分析其咽拭子标本的采集、涂片、染色、镜检情况是否合格,并比较这些标本中细菌培养鉴定及其药敏试验结果对合理用药的影响。结果:150例患儿咽拭子经涂片、革兰染色、镜检,被判定为合格标本者73例(48.67%)和不合格标本77例(51.33%);合格标本按咽拭子涂片镜检标准(A、B、C、D)分级,其中A和B级培养致病菌(是指产ESBLs肠杆菌科细菌)阳性率分别为75.00%和63.64%;不合格标本中(分级为C和D级)培养致病菌阳性率分别为16.67%和1.89%;咽拭子细菌培养阳性标本56例中,检出产ESBLs大肠埃希菌23例(其中多重耐药6例)、肺炎克雷伯菌29例(其中多重耐药10例)和其他细菌4例;大肠埃希菌和肺炎克雷伯菌对氨苄西林、哌拉西林的耐药率均大于90%,而对利福霉素的敏感率均大于80%。结论:咽拭子采样标本合格与否是保障细菌培养和药敏试验结果准确的前提;临床应根据细菌培养及药敏结果合理选用抗菌药物治疗,以减少耐药菌的产生,确保其治疗的有效性。

Analysis on Bacterial Culture Results and Drug Resistance of Pharyngeal Swab in150 Children with Upper Respiratory Tract Infection

Objective:To explore the results of microscopic examination and bacterial culture of pharyngeal swab specimens of children patients,and to analyze the drug resistance of enterobacteriaceae producing extended-spectrum beta-lactamase(ESBLs)in patients with upper respiratory tract infection,so as to provide reference for rational selection of antimicrobial agents in clinical practice.Methods:The data of 150 pharyngeal swab samples from children in the outpatient department of upper respiratory tract infection in hospitals from July 2018 to March 2020 were selected to analyze whether the collection,smear,staining and microscopic examination of pharyngeal swab samples were qualified,and the influence of bacterial culture and identification in these samples and drug sensitivity test results on rational drug use was compared.Results:After smear,Gram staining and microscopic examination,73 cases(48.67%)and 77 cases(51.33%)of the pharyngeal swabs of 150 children were considered as qualified specimens and 77 cases(51.33%)of unqualified specimens.Qualified specimens were classified based on the standard of pharyngeal swab smear microscopy(A,B,C,D),and the positive rates of grade A and B cultured pathogens(ESBLs-producing enterobacteriaceae)were 75.00%and 63.64%,respectively.In the unqualified samples(grade C and D),the positive rate of pathogenic bacteria in culture was 16.67%and 1.89%respectively.Among the 56 positive specimens cultured from throat swabs,23 ESBLs-producing Escherichia coli(including 6 multi-drug resistant cases),29 Klebsiella pneumoniae(including 10 multi-drug resistant cases)and 4 other bacteria were detected.The drug resistance rates of Escherichia coli and Klebsiella pneumoniae to ampicillin and piperacillin were over 90%,while the sensitivity rates to rifamycin were over 80%.Conclusion:Whether the sample of pharyngeal swab is qualified or not is the premise to ensure the accuracy of bacterial culture and drug susceptibility test results.In order to reduce the production of drug-resistant bacteria and ensure the effectiveness of the treatment,antimicrobial therapy should be selected reasonably based on the bacterial culture and drug sensitivity results.